Correctly diagnosing Lyme disease continues to be one of the most significant challenges faced by patients and the wider medical community. Misdiagnosis rates (that we can quantify) are extremely high, as the chronic form of the disease often mimics other chronic disorders. In addition, because Lyme disease isn’t fully legitimised by the CDC (Centers for Disease Control and Prevention), many doctors are under-educated on the effects and symptoms. However, getting the diagnostic stage right is critical for successful eventual treatment of the disorder. So what exactly is involved in testing for Lyme disease, and what is the science behind it?
Lyme disease comes in two distinct forms. The initial stage, known as the acute stage, is widely accepted as a legitimate disorder, contracted from tick bites. The latter stage of the disease, known informally as the ‘chronic’ form, is a much greyer area. Although mainstream medicine has made some concessions to the existence of this disorder, naming it ‘post-treatment Lyme disease syndrome’, the full extent of chronic Lyme symptoms are not generally accepted. Despite this, thousands upon thousands of people all over the globe suffer with this disease on a debilitating daily basis. Proper testing for chronic Lyme disease is therefore a somewhat specialised procedure, conducted by only a handful of Lyme-literate laboratories. It’s possibly more correct to say that the procedure itself isn’t specialised, but the reading and application of the results is.
The science behind acute Lyme testing is straightforward. The patient presents to their doctor with flu-like symptoms. If either the patient or doctor discover the distinctive bullseye-shaped rash somewhere on the body, then it’s a definite indicator of Lyme. It’s also helpful if the patient remembers being bitten by a tick in recent days or weeks. Once acute Lyme is confirmed by either a bullseye rash or tick encounter, the doctor prescribes a course of antibiotics, and the infection usually clears up soon after.
However, when the acute stage of the disease is missed, the Lyme-causing Borrelia burgdorferi bacteria becomes entrenched in the system, reappearing as a diverse spectrum of debilitating symptoms after weeks or even months of being dormant. In this case, Lyme disease is usually not suspected by the patient due to them not remembering a tick bite, leading to a long period of frustration and potential misdiagnosis. Eventually, attention might turn to the possibility of Lyme, and this is where the testing begins. An ELISpot test is the traditional tool used in testing for Lyme disease. This is a common blood test used by doctors for a vast number of reasons.
The ELISpot detects the presence of cytokines and growth factors within a single cell. Cytokines are small proteins secreted by cells of the immune system, and are important for cell-signalling (the way cells communicate with each other). This makes it a valuable tool for all kinds of disease testing, and it’s ostensibly the perfect tool for detecting Lyme disease.
However, the traditional ELISpot only tests for one type of T-cell cytokine: the attacker variant. T-cells are a form of white blood cell, and represent the first line of immune defence when it comes to pathogens. They are dispatched through the blood to the infection site. Their presence, or lack thereof, can alert doctors to the stage and presence of an infection. However, the ELISpot doesn’t return results for memory T-cells – the type of cells that forms after an infection, with the intent of providing a more rapid and effective response if the same infection arises again. It only tells doctors if attacking T-cells are present.
When it comes to chronic Lyme disease, the difference between these two is crucial. Many of the primary symptoms of chronic Lyme are caused by inflammation. In other words, this is the body’s own response to the long-term Lyme infection. Symptoms such as joint pain, muscle pain, fatigue and headaches are all by-products of an inflamed immune response. Depending on the actual stage of the disease, there can be very little of the actual initial Borrelia burgdorferi infection present in a patient. Yet because the inflammation response is triggered, it can manifest constant symptoms, with no hope of recovery. The traditional ELISpot only tests for traces of infection, which is why it can return a false negative if the disease is in its later stages.
BCA-clinic, a Lyme-specialist clinic in Augsburg, recently supported the development of a new ELISpot test: the LymeSpot. This test is designed to give doctors a much clearer reading of the patient’s status, as it tests for both attacking T-cells and memory T-cells. In particular, it tests for IFN-gamma molecules, which are produced by the attacking antigen-specific T-cells travelling through the blood, while simultaneously testing for IL-2 molecules, which are produced by the antigen-specific effector memory cells. The results allow doctors to determine if the Lyme infection is in the acute stage, controlled chronic stage, or full-blown chronic stage. If only IFN-gamma molecules are detected, it’s acute. If only IL-2 molecules are detected, it’s chronic. If both molecules are found together, it’s controlled chronic.
These results allow doctors to decide on the right treatment path, as the treatment for the various stages of Lyme differs considerably. This LymeSpot test should become industry-standard sooner rather than later, as it helps give a much clearer picture of a patient’s position on the Lyme spectrum. Of course, a useful first step would be the full legitimisation of chronic Lyme disease as the major disorder it is.